Vaginal Pessary Versus Expectant Management for Placenta Previa

While the use of pessary in this scenario has not been previously assessed, it is reasonable
to infer, from the data for use of pessary to prevent preterm birth, and the data regarding
the efficacy of cervical cerclage in reducing bleeding and preterm birth in patients with
placenta previa to this clinical conundrum. If cerclage improves pregnancy outcomes in
patients with placenta previa, the use of a vaginal pessary should be a less-invasive but
similarly efficacious alternative to maintain cervical length. The purpose of this study is
to compare two treatment options reasonably used in clinical practice. Use of cervical
pessary is not expected to increase antenatal costs beyond the minimal cost of the pessary.
Additionally, given the results of the available clinical trials on cerclage maintaining
cervical length and decreasing bleeding, this procedure has the potential to decrease the
cost of both antepartum admissions for bleeding and neonatal care.

A substantial number of women with placenta previa will not hemorrhage until they reach the
third trimester, thus, by allowing for enrollment and pessary placement as late as 32w0d, the
intervention may be applied to the broadest "at risk" population. As previously mentioned
literature on the use of cerclage in patients with placenta previa and short cervix are
limited by a reduced number of eligible subjects and concern over safety issues has not been
assuaged by these small studies. As pessary placement appears to carry little if any risk
based on a number of published studies, eligibility can be expanded to any cervical length.

Inclusion Criteria:

- Participant age 18 years or older

- Gestational age between 22w0d and 32w0d, inclusive, at time of enrollment

- Singleton pregnancy

- Complete Placenta Previa

- Intact Membranes

- No allergies to material in pessary

- Plan to deliver at PI's hospital

- Informed consent obtained, signed/dated

Exclusion Criteria:

- Active preterm labor

- Nonreassuring fetal heart rate tracing

- Intrauterine fetal death

- Active bleeding (may be enrolled if hemostatic >48 hours)

- Ruptured membranes

- Any fetal condition likely to cause serious neonatal morbidity independent of
gestational age: Fetal malformation likely to require surgery, Fetal malformation
involving vital organs, Fetal viral infection, Hydrops fetalis,

- Known Uterine Anomaly

- Cervical Cerclage present at time of enrollment

- Maternal condition that warrant continued hospitalization (example severe
preeclampsia, Diabetes out of control, maternal heart disease)